=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063919926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVAN HOWARD CHERNOFF DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2018
-----------------------------------------------------
Last Update Date | 02/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 FRONT ST
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-4600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 872-231-3162
-----------------------------------------------------
Fax | 702-977-1496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 22239
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10087-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-899-0595
-----------------------------------------------------
Fax | 702-977-1496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 314154
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------